CASE REPORT

Niger J Paed 2015; 42 (3):228 –230

Belonwu R

Non-accidental dettol poisoning in a

day old neonate : a rare form of

child abuse

DOI:http://dx.doi.org/10.4314/njp.v42i3.11

Accepted: 26th February 2015

Abstract: In Nigeria, Dettol

Antiseptic Solution poisoning is

an uncommon occurrence in all

age groups. In a registered child

specialist clinic in Kano, a three

granules that was meant to supple-

ment baby’s feed. Greater vigi-

lance on single mothers and coor-

dinated services to single mothers

is highly advocated to improve

maternal – infant bonding and

hence reduce infanticidal ideas.

(

)

Belonwu R

Department of Paediatrics

Aminu Kano Teaching Hospital Kano

Nigeria.

–

day old neonate presented with

Email: raybeloo@yahoo.com

clinical features believed initially

to be due to neonatal seizures and

sepsis, but which turned out to b_®e

due to non-accidental dettol

key words:

Dettol Poisoning,

Neonate, socially disadvantaged

mother, child abuse

poisoning by a single

mother

who contaminated the glucose D

Introduction

well in the 1 24hrs after birth and that poor suckling

developed subsequently. He had been placed on oral

glucose water to supplement the alleged inadequate

breast milk. The child was said to have been sleeping

excessively and had been feeding infrequently. He had

passed normal stool three times on the day of presenta-

tion.

Dettol Antiseptic solution is one of the chemical disin-

fectants used in the homes and it is recognizable by its

distinct odour. The components are chlorxylenol

4.8%,), pine oil (9%) and isopropyl alcohol (12%) .

While the chlorxylenol and pine oil can cause renal fail-

ure and hepatitis, the 3 components can cause additive

(

central nerv_®ous system depression . With passage of

On examination, he was a full term male neonate with

the following anthropometric measurements: weight –

3.37kg (digital scale), occipito –frontal circumference

(OFC) – 37cm and length – 51cm. He was unconscious

with Glasgow coma score (GCS) of 11 and had gener-

alised tonic seizures and bicycling movements involving

both lower limbs. Other pertinent findings included

mild jaundice, bilateral eye discharge and exaggerated

bowel sounds. Respiratory rate was 48 cycles/min, heart

time, dettol has unfortunately become a notorious

chemical for its role in accidental and intentional poi-

soning in children and adults as reported widely in vari-

-8

ous studies . While most studies agree that accidental

ingestion of drugs, household₉_,₁c₀hemicals (including det-

tol ) and therapeutic mishap

are the common causes

of poisoning in children, especially in those less that

five years of age, there has been no sp_®ecific report of

non-accidental poisoning with dettol in a neonate.

•

rate – 120/min regular and temperature was 37• °C.

This report presents a case of dettol poisoning in a

Urgent random blood sugar was 1.1mmol/litre. Full

blood count result was normal. Serum bilirubin and

renal function tests were not done due to logistic rea-

sons. Based on the above findings, a clinical diagnosis

of neonatal seizure secondary to hypoglycaemia was

made. A differential diagnosis of septicemia was enter-

tained and patient was commenced on phototherapy,

and jaundice cleared within 24hrs. Intravenous 10%

glucose 4ml/kg was given bolus and was maintained on

intravenous paediatric saline. Nasogastric tube feeding

was commenced with artificial milk and the mother was

encouraged to breast feed baby any time he was awake.

He was commenced empirically on intravenous antibiot-

ics (ampicillin-cloxacillin and gentamycin), and pheno-

barbitone 7.5mg 12hourly via nasogastric tube. On sub-

sequent reviews for 2 consecutive days, the persisting

complaint was prolonged sleep and that the baby hardly

opened his eyes and so was not able to suckle. At that

juncture a decision was made to withdraw oral pheno-

borbitone but even that did not improve alertness. On

three–day old neonate which is a rare form of child

abuse. Therefore this report will serve as an alert signal

to sensitize health care practitioners.

Case Report

A three-day old male neonate was brought to the con-

sulting room of a child specialist clinic in kano city

Nigeria with complaints of fast breathing and poor suck

of two days duration. He was born in a secondary

health facility located in Kano city; pregnancy, labour

and delivery were not adversely eventful. Mother did not

however receive antenatal care. The neonate is the only

child of the unmarried young lady aged 20yrs who just

completed secondary education. It was the parents of the

biological father (himself a young secondary school

leaver) who took care of the delivery bills and brought

the new born to the clinic.

Further questioning revealed that the child was suckling

the 4 night of admission, the grand mother of the new-

It therefore presupposes that without a high index of

suspicion, children including newborn who are being

abused may pass through the health personnel with their

risks undetected as it nearly happened in our index pa-

tient. It is equally noteworthy that it was the grand

mother of the patient, and not the clinic personnel that

initially detected that the glucose granules which was

born who decided to sleep over that night observed that

the glucose D granules which was with them smelt of

dettol and promptly withheld it. It was the next morn-

ing after the discovery that the attention of the pediatri-

cian –in –charge was drawn to the dettol contaminated

glucose D granules who confirmed the smell and noted

the brownish discoloration of the glucose granules. On

further enquiry, the mother of the baby confessed that

she had been giving it to the baby right from home and

had continued in the hospital. She stated that she did not

want the child to survive and become an unnecessary

obstacle to her future academic career, being unmarried.

That same night, the child woke up twice and took milk.

Later in the day, the child was fully awake and was

feeding regularly and frequently. He was discharged

accordingly after four days of hospitalization after

counselling the young mother and the guardian grand

parents. No toxicologic screening to assess the level of

dettol was done as the area of practice lacked such

capacity. The child was lost to follow up.

being used to supplement the new born s feed was det-

tol – contaminated. This again highlights the need for

greater diligence and commitment on the part of health

care givers as well as emphasizes important roles rela-

tions can play in patient management.

The mother did not receive any antenatal care apparently

because of the circumstances of the child’s pregnancy,

and so her psychological status during pregnancy and

immediately after delivery remains a matter of conjec-

ture. Probably, she was depressed and acted it out by

attempting to poison her baby. This is in keeping with

earlier studies that showed that some disadvantaged

mothers who are single parents, unemployed, poor a₂n₄d_–

with lower educational level have infanticidal ideas

. The index case has brought to the fore the enormous

challenges faced by unmarried young ladies with preg-

nancies in Nigeria. These ladies are generally not sup-

ported by their families either due to poverty or cultural

reasons and there is no clear government policy on how

to take care of their wellbeing. This has led many of

them to engage in self-help initiatives, such as patroniz-

ing nursing homes often regarded derogatorily in Nige-

ria as ‘baby factories’ to get some measure of care .

Where the children of these single mothers are not

adopted, the children certainly will be at grave risk of

suffering abuse, hence there is great need to plan and

improve the mental well-being of single mothers to

stave off the risk of child abuse which may culminate in

infanticide. Properly organized adoption procedures and

foster care will be h_®ighly beneficial. Despite the fact that

diagnosis of dettol poisoning was made later in the

Discussion

Acute accidental and non-accidental poisoning in chil-

dren has remained a major public health problem and it

has continued to be a common medical emergency in

childhood in developing and developed countries of the

2,11-15

world

In recent years, various studies are replete with the no-

toriety of dettol as agent of both accidental and inten-

tional poisoning with varied mortality rates

ever, most reported cases of dettol poisoning involved

adults and adolescent boys and girls who engaged in

,3-6 .

How-

-5

deliberate self poisoning . In Nigeria the only reported

case of dettol poisoning was a case of₂accidental poi-

soning in the study by Asindi at Calabar, and even that

particular case in his series was asymptomatic.

management, the clinical features of dettol poisoning

were evident right from time of admission, and included

respiratory distress due probably to pulmonary aspira-

tion, digestive disturbances with increased bowel sounds

and stool frequency (despite poor feeding), prolonged

sleep as a consequence of central nervous system de-

pression which are all in keeping with the findings of

In our index patient the mother deliberately contami-

nated the glucose D granules with dettol antiseptic so-

lution with the intention to poison the newborn child.

This is obviously a clear case o₆f_-₁₈child abuse as the aim

was to cause harm to the baby . This kind of abuse

is rarely reported as noted in an earlier study by mark

and mark who reported seven cases of non-accidental

4,5

Sherat Kumar and other authors .

poisoning involving other house hold chemicals . What

is even more intriguing is that the mother of the baby

continued the act even while in the hospital, and this

underscores the need for greater vigilance and thorough

assessment when dealing with mothers who fulfill the

criteria for commiting child abuse that may lead to

Conclusion

In conclusio_®n, the knowledge of chemical poisoning

using dettol either for self poisoning or non-accidental

poisoning of others now exists in Nigeria and may be

other developing countries. Therefore household use as

a disinfectant should be monitored, especially among

vulnerable groups (single mothers and adolescents) who

may use it to harm young children or themselves. There

is also the need to establish regional poison control/

toxicologic screening centers to enhance capacity for

early detection and management of poisoning cases

infanticide . The practice of continued child abuse

while in hospital had earlier been documented in a multi

recording

center stu₂d₁ y in the United Kingdom using covert video

It is noteworthy that the patient presented with signs and

symptoms ascribable to neonatal seizure and septicemia

which are common presentations of newborn babies in

22,23

Nigeria and elsewhere

including dettol antiseptic solution

Conflict of Interest: None

Funding: None

There is a great need for creation of well co- ordinated

services for single mothers to care for their physical and

mental well-being during pregnancy and immediately

after delivery to enhance maternal – infant bonding

which will go a long way to eliminate child abuse ideas.

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